Topicals for Use with Microneedling
Autologous platelet concentrates (PRP or PRF) applied prior to microneedling represent the most effective topical adjunct, with PRF demonstrating superior outcomes to PRP when combined with microneedling for acne scars and skin rejuvenation. 1
Primary Topical Options
Autologous Platelet Concentrates (First-Line)
Platelet-Rich Fibrin (PRF) is the preferred autologous concentrate based on comparative studies showing 3-fold greater therapeutic response versus PRP when combined with microneedling. 1
- Application timing is critical: APCs must be applied to the skin before microneedling to allow the needling effect to push growth factors into the dermis 1
- PRF clots within 20-40 minutes if left in the syringe; exposure to oxygen accelerates clotting 1
- Treatment protocol: 3 sessions spaced 1 month apart, then maintenance every 6 months 1
- Ensure skin is well lubricated with APCs during the procedure to avoid dry tugging sensation 1
Platelet-Rich Plasma (PRP) remains an effective alternative when PRF is unavailable:
- Combined microneedling with PRP shows significantly higher improvement rates versus microneedling alone for acne scars 1
- Patient satisfaction scores are greater with PRP compared to vitamin C when combined with microneedling 1
- One outlier study (Gupta et al.) showed no added benefit, but PRP was applied after microneedling rather than before, explaining the divergent result 1
Vitamin C (Alternative Option)
Vitamin C can be used as a topical during microneedling, though evidence shows inferior results compared to PRP. 1
- One study demonstrated PRP combined with microneedling produced better outcomes than microneedling with vitamin C for atrophic acne scars 1
- Poor response rates: 37% with vitamin C versus 22.2% with PRP at 4-month follow-up 1
Topicals to Avoid During Microneedling
Do not apply the following during active microneedling procedures:
- Topical antibiotics (clindamycin, erythromycin) - these are for acne treatment maintenance, not for use during microneedling procedures 1
- Topical retinoids (tretinoin, adapalene, tazarotene) - these should be discontinued before microneedling to avoid excessive irritation 1, 2
- Benzoyl peroxide - not indicated for use during microneedling procedures 1, 2
- Heavily scented facial creams/products - avoid for 24 hours post-procedure 1
Pre-Procedure Topical Anesthesia
- Use compounded topical anesthesia (pharmacy-based, not over-the-counter) for at least 30 minutes prior to procedure 1
- Ensure anesthesia is completely removed before beginning microneedling 1
Post-Procedure Considerations
Critical post-treatment instructions:
- Advise patients to avoid sunlight and heavily scented facial products for 24 hours post-procedure 1
- Expected downtime is typically 24-48 hours 1
- Minimal risk of post-inflammatory hyperpigmentation when proper technique is used 1, 3
- Side effects are generally mild and self-limited: erythema, pain, edema, temporary skin irritation 4, 5
Safety Profile Across Skin Types
Microneedling with appropriate topicals is safe for all skin types, including darker skin (Fitzpatrick types III-V). 5, 3
- No worsening of pigmentation reported in studies of patients with dark skin when proper technique used 3
- Transient side effects include redness, mild dryness, and small hematomas 3
- Post-inflammatory hyperpigmentation risk is lower than with lasers or deep peels 1
Clinical Outcomes by Indication
For acne scars: Microneedling combined with APCs shows higher odds of achieving notable/complete clinical improvement versus microneedling alone, with 85.4% improvement rates reported. 1
For skin rejuvenation: APCs work through extracellular matrix remodeling, increased matrix metalloproteinase expression, fibroblast proliferation, and collagen synthesis stimulation. 1
For hyperpigmentation: Microneedling effectively treats post-acne hyperpigmentation in darker skin types when combined with appropriate topicals. 3, 6